title: Impacts of clinicopathologic and operative factors on short-term and long-term survival in renal cell carcinoma with venous tumor thrombus extension: a multi-institutional retrospective study in Japan.
abstract: BACKGROUND
  Although the percentage of patients with renal cell carcinoma (RCC) extending into venous systems is unexpectedly high, the prognostic impact and independency of venous tumor thrombus-related factors on overall survival (OS) remain controversial. Furthermore, the prognostic impact of various clinicopathologic factors including tumor thrombus-related factors on OS may change with elapsed years after the intervention and also with follow-up duration of participants. The aim of the study is to explore independent and universal predictive preoperative and intraoperative clinicopathologic factors on OS in patients with RCC extending into venous systems using subgroup analysis in terms of restricted follow-up duration and yearly-based survivors.
  
  
  METHODS
  Between 1980 and 2009, 292 patients diagnosed with RCC with venous tumor thrombus were retrospectively registered for this study. The prognostic impacts of various clinicopathologic and surgical treatment factors including levels of venous thrombus, venous wall invasion status and likelihood of aggressive cytoreductive operation, were investigated using Kaplan-Meier method and following multivariate Cox proportional hazards model for all patients and those still alive at 1, 2, and 3 years of follow-up. To investigate the impact of follow-up duration on the statistical analyses, multivariate logistic regression analyses were used to explore prognostic factors using restricted data until 1, 2, and 3 years of follow-up.
  
  
  RESULTS
  The median follow-up duration was 40.4 months. The 5-year OS was 47.6%. Several independent predictive factors were identified in each subgroup analysis in terms of yearly-based survival and restricted follow-up duration. The presence of tumor thrombus invading to venous wall was independently related to OS in the full-range follow-up data and in survivors at 2 and 3 years of follow-up. Using restricted follow-up data until 1, 2, and 3 years of follow-up, many independent predictive factors changed with follow-up duration, but surgical category could be universal and independent predictive factors.
  
  
  CONCLUSIONS
  The most universal factors affecting improvement both in short-term and long-term survivals could be cytoreductive surgery and absence of venous wall invasion. It may mean that feasible aggressive cytoreductive operation following more reliable preoperative imaging for predicting venous wall invasion status would improve OS for patients with RCC extending into venous systems.
authors.affiliation: Division of Urology, Isesaki Municipal Hospital, 12-1, Tsunatori-hon-machi, 372-0817 Isesaki, Gunma, Japan. kzito@med.gunma-u.ac.jp.
authors.forename: Masanori
authors.initials: M
authors.lastname: Hirono
authors.forename: Mikio
authors.initials: M
authors.lastname: Kobayashi
authors.forename: Tomoyasu
authors.initials: T
authors.lastname: Tsushima
authors.forename: Wataru
authors.initials: W
authors.lastname: Obara
authors.forename: Nobuo
authors.initials: N
authors.lastname: Shinohara
authors.forename: Keiichi
authors.initials: K
authors.lastname: Ito
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Eto
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Takayama
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Fujii
authors.forename: Masaharu
authors.initials: M
authors.lastname: Nishikido
authors.forename: Go
authors.initials: G
authors.lastname: Kimura
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kishida
authors.forename: Masayuki
authors.initials: M
authors.lastname: Takahashi
authors.forename: Noriomi
authors.initials: N
authors.lastname: Miyao
authors.forename: Yukio
authors.initials: Y
authors.lastname: Naya
authors.forename: Takashige
authors.initials: T
authors.lastname: Abe
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Fujioka
authors.forename: Kazuto
authors.initials: K
authors.lastname: Ito
authors.forename: Seiji
authors.initials: S
authors.lastname: Naito
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009362:Neoplasm Metastasis; D009360:Neoplastic Cells, Circulating; D009392:Nephrectomy; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome; D047368:Tumor Burden; D020246:Venous Thrombosis / Q000209:etiology / Q000473:pathology* / Q000601:surgery